SGU Episode 430

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SGU Episode 430
October 12th 2013
(brief caption for the episode icon)
SGU 429                      SGU 431
Skeptical Rogues
S: Steven Novella
B: Bob Novella
R: Rebecca Watson
J: Jay Novella
E: Evan Bernstein
Quote of the Week
The claim of alternative practitioners to not treat disease labels but the whole patient...allows alternative practitioners to live in a fool’s paradise of quackery where they believe themselves to be protected from any challenges and demands for evidence.
Edzard Ernst
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Show Notes
Forum Discussion

Introduction

You're listening to the Skeptics' Guide to the Universe, your escape to reality.

This Day in Skepticism ()

• October 10, 1871: Chicago fire is finally put out.

News Items ()

2013 Nobel Prizes ()

• in Physics
• in Physiology or Medicine
• in Chemistry

Kansas Citizens Reject Science ()

• http://theness.com/neurologicablog/index.php/kansas-citizens-sue-to-reject-science/

Science Sting on Open Access Journals ()

• http://theness.com/neurologicablog/index.php/a-problem-with-open-access-journals/

Smart Metals ()

• http://www.bbc.co.uk/news/science-environment-24400101

Who's That Noisy ()

• Answer to last week

Interview with Marty Klein (42:34)

• www.martyklein.com

S: Well we are here at TAM 2013 and we are joined by now Marty Klein, Mary welcome to the Skeptics' Guide.

MK: Delighted to be here.

S: And Dr. Klein is a sex therapist and an author of several books including "Sequal intelligence, what we really want from sex and how to get it" and "America's war on sex". So Marty. I'm a sex addict and I need your help. So, how can you help me?

MK: I can help you by giving you the good news that you're not a sex addict.

S: How do you know?

MK: There is no such thing as sex addiction. Sex addiction is morality dressed up as clinical science. Sex addiction is a concept that was invented in 1986 by Patrick Corns, a prison addictionologist.

S: Is that a real thing, addicitonologist, or did you make up that term?

MK: I think an addictionologist is a guy who specialises in addiction.

E: Works for me.

S: OK.

J: It just seems a little hokey, right?

S: It does come off a little hokey, but OK, we'll buy it.

MK: Just like an athlete is a guy who wears an athletic support. So the thing with sex addiction, lots of people make sexual decisions whose consequences they don't like, and people make the same mistake over and over again when it comes to sexuality. And we don't need a new category for that. We already have categories for that, I mean lots of people, lots of human beings, they make decisions, they don't like the consequences, they keep coming back and doing the same thing. So historically, therapy has a good category for that, it's called neurosis, right? More popularly people say oh that guy, he just doesn't learn from his mistakes. I think the attractiveness of the concept of sex addiction is that it allows people to say, it's not me, it's my addiction, it allows people to say, there's something damaged in me that drives these decisions rather than somebody saying you know, I know it's not good for me to do that but at the time, it's very hard for me to think ahead, it's very hard for me to think about consequences when I'm really hungry or tired or lonely. It's hard for me to think of consequences when I'm angry at my wife. It's hard for me to think of consequences when I feel unattractive. And I got a lot of compassion for people like that, it's part of my job, but to call it an addiction I think waters down the meaning of the concept of addiction so much as to render it meaningless.

S: But what about, are there people who are very compulsive in their sexual behaviours...

MK: Yes, absolutely.

S: ...to the point where it's detrimental to their well-being, their functionality.

MK: Of course.

S: Does it ever get to a level where you think it's reasonable to call that kind of compulsive sexual behaviour a sex addiction or would you just use a different term?

MK: Well I see people who wash their hands 40 times a day. I don't call them hand-washing addicts. I say they have obsessive-compulsive disorder, and I don't send them to a hand washing clinic, I help them get their obsessive compulsive disorder treated. Practically any behaviour on Earth can be done in a compulsive way, in a self-destructive way, in an impulsive way. Certainly we see people use the internet in self-destructive ways all the time as well as shopping or a lot of other things. To separate out the content from that and to focus on the content I think is a really big mistake.

J: But what about the idea though, that we absolutely do have a sex drive. We don't have like a hand-washing drive, but sex-drive is something you can feel come and go, right, feel exceptionally aroused or "horny", right? And as an example though, I have a friend, a guy I'm really close with that is like the horniest person I've ever met in my life. Like he talks about sex incessantly, and he's horny all the time.

MK: That's your brother. You're getting confused.

S: Jay has a "friend". A "friend" in scare quotes.

J: I always said to him and other people that know about it that he's a sex addict that he's just over the top. He wants to have sex all the time.

MK: Right so I see these guys in my practice all the time. They come in and they say "I need to have sex twice a day". I say "aha, so you want to have sex twice a day", they say "no, I need to have sex twice a day". That's the mental construct where it starts: I need to have sex. No you don't. I mean let's be serious here, you don't need to have sex twice a day. You need to eat twice a day, you don't need to have sex. What this guy really means is, when I don't have sex twice a day I feel really, really uncomfortable. Really? Tell me all about that. I feel lonely, I feel unattractive, I feel like I'm not a real man. Well, I have a lot of sympathy about that. And that's not a sex addiction, it's not an addiction of any kind, it's not even about sex. It's about how a person feels about themselves or how a person sees themselves walking through the world and fortuntately we have clinical tools to deal with that, they're called therapy.

B: So it's a coping mechanism.

MK: Typically. Typically.

S: So it sounds like what you're saying is that sexual behaviour can be a compulsion that is a manifestation of some other underlying psychological problem.

MK: Of course.

S: So it shouldn't be singled out, the behaviour itself isn't the problem, it's just a symptom of the real underlying problem.

MK: And what happens is, Bob you mentioned a coping mechanism, yeah so there are people for example, their coping mechanism is to be on the board of their church and the PTA and the home owners' association and 5 other boards. That's their coping mechanism. Other guys, their coping mechanism is to work 88 hours a week. The difference with sex as a coping mechanism is that because our society is so nutty about sex, when the coping mechanism is about sex, society focuses on the sex. When the coping mechanism is about other stuff that's more socially approved, people don't get so nutty about it.

S: So why is there such a big bugaboo about sex and morality, why is that such a focus?

MK: well sexuality is a vehicle to experience and express their autonomy and if you were running a church, let's just say, or if you were running a government, let's just say, you wouldn't be so wild about people having this simple, low cost, dependable way of accessing a sense of personal autonomy. I mean it's the church's worst nightmare. So throughout history every big institution has always tried to control people's sexuality, to control fertility, to control who's eligible for sex, what parts of the body are eligible, all of the mental maps that people have about sexualtiy, every religion wants to control that and every government wants to control that. Even in 1984, the book by George Orwell, even in there Big Brother was trying to control people's sexuality.

B: Marty, since the perception of sex is so different between different countries, do you find say more self-described sex addicts in the United States than say, the United Kingdom?

MK: well, the difference in the rate of sex addiction between the US and other countries is not so much about behaviour, it's about the social concept of sex addiction. Just like some countries have a higher incidence of men, you know the old-fashioned word, "hen-pecked"? In some countries they have a lot more of that, but it's not because the women behave differently as much as it's about some countries, they have the concept of hen-pecked and other countries don't. So in the United States which is of course more sexually repressed than say Holand or Norway, yeah we see more people self-identifying as sex addicts and more people getting identified by other people in their lives as sex addicts. I mean in Sweden if a guy wants to have sex with women other than his wife, they don't call him a sex addict, they don't call him a sex addict, they call him Sven.

(laughter)

E: Is this primarily a male phenomonon?

MK: Sex addiction? Well again, I think most of it has to do with social expectations. Women can express their sexuality in a lot of ways privately that other people are not going to raise their eyebrows about and women typically don't pursue, don't usually go to prostitutes, women don't engage sex workers typically, unless you count people who do their hair. So they don't engage workers, they don't read, they don't look at Internet porn nearly as much as men. Men don't complain as much about women being too sexual, what men typically do when their women are too sexual is they just withdraw from them. When women feel that men are too sexual they tend to look for the pathology, they tend to. And I think this is all socially prescribed, all socially prescribed.

E: How about age?

MK: I'm in favour of it.

E: 18 vs 58, I mean what kind of differences are we looking at and do you handle patients differently?

MK: well by 58 people are supposed to have accomplished certain developmental tasks. By 58 you're supposed to know who you are and the way you express your sexuality, in a healthy person, the way you express your sexuality is consonant with who you are, with what your values are. When you're 18 you still don't know what your values are, you still don't know who you are, so sexuality at 18 actually is one of the vehicles that young people use to discover who they are, to discover what's important to me. Do I care about how something feels to the touch when I'm having sex, do I care about whether or not I make an emotional connection with the person I'm having sex with? You know for a lot of 18 year olds, no-one has ever sat them down and said, yeah sex can feel really good in your penis but you know what? Sex can also be a way to get to know somebody else or sex can be a way to feel close to somebody. Not that it has to, but it can be a way, so at the age of 18 people are sort of learning about two things at the same time, they're learning about who they are, and they're learning about sex at the same time. And trying to solve two variables in one equation can be very complicated. At 58 we're supposed to know who we are and we're supposed to know what we care about, some people they care about do you treat somebody nicely, other people they don't care about treating somebody nicely. Of course ate 58 we're struggling with the changes in our bodies that have occurred over the last 40 years. So we tend to formulate our vision of what sexuality is all about between the ages of about 16 and 23 let's say, in America anyway. But during that period of time, the body that we have, we only have that body for a very short period of time. The healthy body, the physically flexibility, the lack of chronic pain, all that stuff. The body that we have when we're putting together our ideas about sexuality, we don't have that body very long, which means that the ideas that we have about sex need to evolve over and over and over again in our 30s in our 40s in our 50s. When we're in our 50s we may not be able to use our favourite position any more because of chronic pain. When we're in our 50s we may have felt when we were 18 what a real man does is he gets on top of a woman in the heterosexual thing. What a real man does is gets on top of a woman. By the time you're 58, maybe your chronic back pain prevents you from getting on top of your partner, so you have to make a new decision about what does it mean to be a man when you're having sex when you can't get on top of a woman.

J: So do you think it's typical that a lot of people just always use the type and quantity of sex that they had in those early formative years and that's kind of the bar that they're always comparing their current sex life to?

MK: That's very, very common. I mean ejaculation is a really good example. When guys are 18 it's really easy to ejaculating, in fact people are ejaculating all over the place when they don't want to. Listening to a podcast, you know guys are ejaculating. So it's really easy to ejaculate when you're 18. When you're 58 it's not so easy any more. You could have the most perfect stimulation in the world, it's just not that easy to ejaculate when you're 58. So you could decide well, that's OK, or you could decide, uh, oh what's wrong with me? You might actually go from woman to woman to woman in a desperate attempt, not because you're a sex addict, but you go from woman to woman to woman because you want to find a woman with whom you can ejaculate, and then you feel like, OK I'm sexually normal. Most people are desperate to feel sexually normal and if the way you define sexually normal is sex the way it was when you're 19, oh you're in big trouble, big trouble.

J: Yeah.

E: We try to avoid the term normal in a lot of discussions we have about this topic and other topics, I think "normal" itself has become a little bit of a taboo in a sense, like what is normal, you really can't define that and you really shouldn't be using that term.

MK: And yet people do.

E: Right, of course they do, it's just nomenclature.

J: It's their fallback right, it does speak to, when we say normal, we're basically say what, the average?

S: There's more of a connotation though than just average.

MK: There's a moral dimension to it.

S: Yeah, because the opposite is "abnormal" it's not just atypical or, there's gentler terms that are... but when you're a therapist you deal more with healthy, you use the term "healthy" vs "counter-productive" or "unhealthy" behaviour, that has more of the right connotations.

MK: Right. My patients don't but I do. I mean they desperately want to be normal and when I'm training other therapists, I say don't help your patients feel normal. You know, somebody comes in, I like to have sex with a chicken. Or somebody comes in, I like to have sex with the lights on, or I like to have sex with the lights off and I'm afraid I'm not normal. What most therapists do is, oh sex with the lights on, don't worry, that's normal. The problem is that what the patient's not telling us is that they're into having sex with a chicken, right? So what patients really need is not to feel normal but rather to get off of the normal/abnormal merry-go-round. The question is not: is your sexuality normal? The question is: does your sex work for you and for the people you're having sex with? Is it consonant with your values as a person? And what normal sex is going to look like for somebody when they're 50 is probably going to be different from what it looked like when you were 20 so we just have to get rid of that idea of normal all together. Most people have not learned to trust themselves enough sexually, most people have certainly not learned to trust their bodies enough sexually. So if you're with somebody and you're really excited but you don't lubricate, that doesn't mean that there's something wrong, it doesn't mean that you don't love the person, it may be that you're body is just not lubricating. Now let's just go and have sex anyway. But a lot of people haven't learned to trust their bodies when it comes to sex. And so the first explanation they go to, the pathology explanation is you know, what's wrong here? And we've got to get people off of that normal merry-go-round.

J: Marty. Do people actually have sex with chickens?

MK: Well, let's just say that if you don't want to do it, you don't have to do it.

S: But that's a thing?

J: I mean did you ever have someone come in and say, yeah I'm banging a chicken? I've got to know.

MK: Well no. No, but let me tell you this, let me tell you this. When I train therapists, they say well, how do you deal with patients who express their sexuality in ways that you don't have experience with. So you know, I've never been pregnant, I have to talk about what it's like to have sex when you're pregnant. Or I've never been in a wheelchair but how do we talk to people about having sex when they're in a wheelchair? And when people are into some sort of fetish or paraphelia, how do you talk to people if you've never had sex with a chicken right, and somebody comes in and they say I fantasize about having sex with a chicken. And what I say to my students is, well put yourself in the place of the person who is in to having sex with the chicken. How would you feel? You would feel lonely, you would feel embarassed, you would guilty, you would feel I can't tell anybody about it, you know, Monday morning at the water cooler, people are talking about what a great weekend they had, you can't say yeah, and I had a sex with a Rhode Island Red or something. So there are things, most people don't have sex with chickens, but when people are being sexual or people have sexual fantasies, if you can look at that as just part of the human parade, if you can not segregate sex outside of people's lives but actually think about it inside of people's lives, then we can think about people feeling guilty or people feeling ashamed or for that matter people feeling connected, you know somebody might say when I fantasize about having sex with a chicken, I feel smart, I fell powerful, I feel capable, well we can all relate to that. You know, and then the question might be, are there other ways you can feel smart and capable during sex, and maybe do it with somebody a little bit closer to your own size.

S: I have two related questions. One is, do you get patients who come in wanting to be "cured" of their homosexuality. And two, do you have patients who confess to being a paedophile and want to be treated for that, and what are your thoughts on that?

MK: Well, as far as the gay thing, I practice in the San Francisco Bay area so we don't get a lot of people who are complaining about being gay, mostly they live in the San Francisco Bay area. So no, I've actually never had... now I've had a lot of people who say, I'm into such-and-such and I don't want to be in to such-and-such which leads into your question about paedophilia, but to talk about something a little softer first, there are people who say I can't get off unless the woman's wearing black leather boots and is smoking a cigarette and dropping the ash on my balls and I'd rather that not be my sexual orientation. Turns out it's really hard to change somebody's sexual orientation. My approach is always to expand somebody's sexual vista rather than change it.

S: OK. I want to clarify one thing. So it seems to me what you're saying is, a lot of sexual desires and behaviours are driven by some other underlying typological issue and it's not about the sex, but are there also people who have paraphilias or you said fetishes that are about the sex, it just happens to be the way their brain is hard wired or whatever, just something makes them really sexually turned on by shoes or whatever it is, that's not about some other deeper issue, it's just about the shoes, is that also the case?

MK: You know that's a good question, and I don't want to be disingenuous but the answer is, it depends on who you ask. Because there are some professionals who will tell you, having thought about it very carefully, that fetishes are always about something. I'm not of that opinion. I think that... and since we're probably not going to change somebody's fetish anyway, in a sense it doesn't actually matter what it's about, but more it matters, so what are we going to do with this phenomenon? The same way that if you're a really tall person living in an apartment with a really low ceiling, what are we going to do about that? So somebody comes in and fetishes typically develop very early in life. You know, ever since you were six you liked mommy's high heels, and you liked to caress them and kiss them when you were six. You weren't ejaculating when you were six, but you used to like to caress them and kiss them and maybe sleep with them under your pillow and this and that. By the time you're 14 now you like to ejaculate on them, and then when you're 30 you know, you like to be stepped on while you're masturbating or whatever. So we can say high-heeled shoes on this program, right?

S: Absolutely.

(laughter)

MK: So, whether it's hard-wired per se, or whether it's wired in really, really early, partly that's a philosophical difference but it's almost invariably wired in really, really early and notoriously difficult to change.

J: But you can develop a fetish, though.

S: Is that right? Can you develop a fetish as an adult?

MK: It doesn't happen very often and if it does, you could almost say by definition it's not a fetish, I mean you could be trapped on a desert island for 30 years and all the women there are all 8 feet tall and then you come back to Connecticut and the only women you're interested in are 8 feet tall, and then the question is is that a fetish or not?

S: Alright well Marty Klein thank you so much for sitting down with us, we really appreciate it, a fascinating talk, author of "Sexual Intelligence" and "America's War on Sex" among other books.

MK: And my newsletter "Sexual Intelligence", you undoubtedly want to mention.

S: And your website, give us your URL.

MK: sexed.org.

J: Thanks Marty.

S: Thanks Marty.

Science or Fiction (1:04:50)

Item #1: Scientists have discovered the first evidence of a comet striking the earth – part of a comet nucleus. Item #2: Researchers have discovered a method for inhibiting the propagation of prion proteins, potentially leading to a cure for mad cow and related diseases. Item #3: Physicists have created stable exotic calcium nuclei (with 20 protons and 34 neutrons), suggesting the existence of a previously unknown force operating at nuclear scales.

Skeptical Quote of the Week ()

'The claim of alternative practitioners to not treat disease labels but the whole patient...allows alternative practitioners to live in a fool’s paradise of quackery where they believe themselves to be protected from any challenges and demands for evidence.'- Edzard Ernst

S: The Skeptics' Guide to the Universe is produced by SGU Productions, dedicated to promoting science and critical thinking. For more information on this and other episodes, please visit our website at theskepticsguide.org, where you will find the show notes as well as links to our blogs, videos, online forum, and other content. You can send us feedback or questions to info@theskepticsguide.org. Also, please consider supporting the SGU by visiting the store page on our website, where you will find merchandise, premium content, and subscription information. Our listeners are what make SGU possible.

References